![]() ![]() Declaration and Registration of Informal Marriage if common lawĪ.Identification for you and your husband or wife You will be asked to sign the Medication Assistance Program (MAP) Consent and Authorization Form (Form #283233) that tells Harris Health to share your personal health information and sign any forms that are needed for you to get free medicine.ġ. Harris Health's pharmacy staff can sign you up for patient assistance programs to get free medicines from drug companies. ![]() Please make and give Harris Health copies of the following papers with your application (This information, papers and signatures are required for Harris Health Financial Assistance, Drug Replacement programs and some federal grants.) (Third Wednesday of the month, open 7:30-11 a.m.)ĪPPEALS PROCESS If you disagree with the eligibility determination stated on the Harris Health System Notice you received, please complete an appeals form ( English, Spanish, Vietnamese) and mail within 65 calendar days from the date of your notice to:Įligibility Appeals Committee Harris Health System P.O. (Fourth Thursday of the month, open 7 a.m.-noon) (Second Wednesday of the month, open 8 a.m.-noon) (Fourth Thursday of the month, open 8 a.m.-noon) d. Drop-off your completed application and proof documents in the eligibility drop box at the following locations at the front door of each health center. c. Complete all sections on your application and attach proof documents.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |